Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Synergistic effect of independent risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis: a multicenter retrospective study in Japan

  • Hirokazu Saito (Department of Gastroenterology, Kumamoto City Hospital) ;
  • Yoshihiro Kadono (Department of Gastroenterology, Tsuruta Hospital) ;
  • Takashi Shono (Department of Gastroenterology, Kumamoto Chuo Hospital) ;
  • Kentaro Kamikawa (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Atsushi Urata (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Jiro Nasu (Department of Gastroenterological Surgery, Kumamoto Chuo Hospital) ;
  • Masayoshi Uehara (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Ikuo Matsushita (Department of Gastroenterology, Kumamoto Chuo Hospital) ;
  • Tatsuyuki Kakuma (Department of Biostatics Center, Medical School, Kurume University) ;
  • Shunpei Hashigo (Department of Gastroenterology, Kumamoto City Hospital) ;
  • Shuji Tada (Department of Gastroenterology, Kumamoto City Hospital)
  • Received : 2023.08.14
  • Accepted : 2023.10.10
  • Published : 2024.07.30
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Abstract

Background/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP. Results: PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033). Conclusions: As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

Keywords

Acknowledgement

We would like to thank the staff involved in endoscopic retrograde cholangiopancreatography at the participating institutions.

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